Individual
DWAYNIE BACON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2410 HIGHWAY 95, BULLHEAD CITY, AZ 86442-7305
(928) 219-4700
Mailing address
2328 RYAN WAY, BULLHEAD CITY, AZ 86442-8699
(702) 292-3798
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S026811
AZ
Other
Enumeration date
04/24/2025
Last updated
04/24/2025
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